Specificity of training in cardiac rehabilitation to facilitate a patient's return to strenuous work following aortic valve replacement

Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses

Transcatheter aortic valve replacement (TAVR) is a relatively new treatment method for aortic stenosis (AS) and has been demonstrated to be suitable for patients with varying risk levels. Indeed, among high-risk patients, TAVR outcomes are comparable to, or even better, than that of the traditional surgical aortic valve replacement (SAVR) method. TAVR outcomes, with respect to post-surgical functional capacity and quality of life, have also been found to be improved, especially when combined with cardiac rehabilitation (CR). CR is a multidisciplinary system, which integrates cardiology with other medical disciplines, such as sports, nutritional, mind-body, and behavioral medicine. It entails the development of appropriate medication, exercise, and diet prescriptions, along with providing psychological support, ensuring the cessation of smoking, and developing risk factor management strategies for cardiovascular disease patients. However, even with CR being able to improve TAVR outcomes and reduce post-surgical mortality rates, it still has largely been underutilized in clinical settings. This article reviews the usage of CR during both pre-and postoperative periods for valvular diseases, and the factors involved in influencing subsequent patient prognoses, thereby providing a direction for subsequent research and clinical applications.

The utility of boxing for cardiac prehabilitation

A 56-year-old man with end-stage heart failure performed a 4-week, symptom-limited, progressive inpatient cardiac prehabilitation program while confined to the cardiovascular intensive care unit awaiting heart transplantation. Mobility was limited by an acute gout flare and multiple central venous access lines. He received a tailored prescription of intermittent boxing, supervised hallway ambulation, stair training, and golfing on a putting green on four consecutive weekdays and was encouraged to mobilize with nursing on the remaining days. The patient progressed and by the last week demonstrated increased activity tolerance. He had a successful transplant after 40 days in the intensive care unit and was discharged with stamina sufficient to participate in outpatient cardiac rehabilitation, demonstrating the value, safety, and feasibility of an individualized inpatient cardiac prehabilitation program for patients with advanced cardiac disease medically confined to the intensive care unit.

Exercise training with cycle ergometry in the intensive care unit after total artificial heart implantation

A 53-year-old male mountain biker received a total artificial heart and remained in the cardiovascular intensive care unit for 56 days. To reduce functional decline caused by inactivity, he performed a six-session cycle ergometer exercise program in his hospital room. Traditional cardiac responses for exercise prescription were not applicable; therefore, a symptom-limited, monitored progression scheme in conjunction with recommendations for the artificial heart was implemented to modify duration and intensity. Over the six sessions, the patient improved his distance pedaled by 320% and functional capacity by 1 metabolic equivalent. He was subsequently discharged from the hospital and later successfully transplanted without readmission.

Is Wii-based motor training better than task-specific matched training for children with developmental coordination disorder? A randomized controlled trial

Purpose: To evaluate in children with developmental coordination disorder (DCD) the effects of Wii-training compared with task-specific matched training (TST).Material and methods: A randomized controlled trial (RCT) was conducted with 32 children having DCD, aged 7-10 years. Children were randomly assigned to the Wii or task-specific training. Both interventions consisted of 16, 60-min sessions over an 8-week period. The primary outcome measure of movement skill was the Movement Assessment Battery for Children-2 (MABC-2), administered by blinded assessors. Measures included total standard scores (TSS), manual dexterity, aiming/catching, and balance component scores.Results: From pre- to post-test, both groups improved significantly on TSS and balance after intervention. The Wii intervention group also improved on manual dexterity. Neither group improved significantly on aiming/catching.Conclusions: Both the Wii and task-specific training improved overall motor performance and balance. On other MABC-2 component scores, treatment effects differed between groups: Task-specific training had more pronounced effects on balance skills, while Wii training had slightly stronger treatment effects than task-specific training on manual dexterity. It was concluded that task-specific training affords stronger benefits for general motor skill than Wii-based training. Whether Wii training can promote clinically significant benefits for upper-limb function remains to be seen.Trial Registration: This study is registered in a clinical trials registry platform (Protocol: RBR-89YDGJ). Available on the Brazilian Clinical Trials Registry <http://www.ensaiosclinicos.gov.br/>Implications for rehabilitationWii-training and task-specific matched training programs afforded gains in motor performance in children with developmental coordination disorder, similarly;The selected Wii tasks were able to improve the motor performance in children with developmental coordination disorder, but should not be used as an exclusive strategy for these children;Our findings suggest caution in recommending Wii-based training as a viable alternative to more task-specific matched training for children with developmental coordination disorder.